Female Pelvis

Front 1

True pelvis = region deep to the pelvis inlet (linea terminalis)

Back 1

- lesser/minor

-situated in the true pelvis includes the bladder, loops of small bowel, genital tract, and ovaries

- tilts inferoposteriorly

Front 2

Normal measurements?

Vaginal cavity ?

Cervical canal ?

Premenarchal uterus ?

Multiparous Uterus ?

Uterine tubes?

Adult ovary?

Ovarian volumes ?

Premenarche (3-15years)?

Menstruating?

Premenopausal?

Postmenopausal

(1-5)?

(10-15)?

Back 2

Back (Definition)

Front 3

Key words

Back 3

Back (Definition)

Front 4

Front (Term)

Back 4

—

Front 5

Front (Term)

Back 5

—

Front 6

Front (Term)

Back 6

Anatomy

Front 7

Front (Term)

Back 7

—

Front 8

Front (Term)

Back 8

-

Front 9

Front (Term)

Back 9

Sono

Front 10

Front (Term)

Back 10

—

Front 11

Front (Term)

Back 11

Back (Definition)

Front 12

Front (Term)

Back 12

Back (Definition)

Front 13

How can you tell if the bladder is appropriately full enough for a pelvicultrasound?

Back 13

It will extend superior to the fundus of the uterus.

Front 14

Why do we have the patient fill their bladder before a scan?

Back 14

To provide an accoustic window for better visibility of the pelvicorgans.

Front 15

What structures are seen posterior to a distended bladder?

Back 15

Uterus, vagina, posterior cul de sac, rectum and ovaries (dependingtheir location)

Front 16

re arrange in the correct order,

anterior to posterior

Skin

Uterus/Vagina

Rectus Abdominus Muscles

Bladder

Spine

Uterus/Vagina

Rectum

Skin

Spine

Back 16

Skin

Rectus Abdominus Muscles

Bladder

Uterus/Vagina

Rectum

Spine

Front 17

What structures are always seen midline?

Back 17

Rectus abdominus muscles,

bladder,

urethra,

vagina,

rectum

andcervix (usually)

Front 18

What structures are seen in the adnexa?

Back 18

Ovaries,

broad ligament,

pelvic wall muscles,

pelvic bones

Front 19

If the uterus is not midline, what are the names of the 2 other positions itcould be?

Back 19

Levorotated

Dextrorotated

Front 20

What are the names of the different uterine positions referring to itsflexion?

Back 20

Anteverted

Retroverted

Retroflexed

Anteflexed

Front 21

What is the average size of a nulliparous uterus?

Back 21

6-8cm

Front 22

4 parts of the uterus ?

and the 3 uterine layers?

Back 22

4 parts = fundus, body, isthmus, cervix

3 uterine layers =

myometrium

endometrium

perimetrium

Front 23

Name the 2 layers of the endometrium?

Which layer is mostly sloughedoff during menstruation?

Back 23

Zona Basalis and Zona Functionalis.

Zona functionalis is sloughed off menstruation.

Front 24

Describe the structure of the vagina, where it’s located and its U/Sappearance.

Back 24

Collapsed muscular tube with a thin mucosa. Located posterior andinferior to the urinary bladder sitting at a 90 degree angle to thecervix.

Front 25

Name the 4 parts of the oviducts?

Back 25

Interstitial/Intramural

isthmus,

ampulla

and infundibulum

Front 26

Describe the structure, location and the ultrasound appearance of the Fallopian tubes?

Back 26

Muscular tubes lined with mucosa attached laterally to the uterus at the cornua.Not visualized on ultrasound unless abnormnal.

Front 27

What is another name for the ovarian fossa?

Back 27

Fossa of Waldeyer.

Front 28

Name the 2 tissue layers that make up the ovary and what structures they contain?

Back 28

Cortex – outer layer; contains the primary follicles

Medulla – middle layer; contains blood vessels, nerves and lymphatics

Front 29

What is the tunica albuginea?

Back 29

Connective tissue covering surrounding the ovary.

Front 30

What is the ultrasound appearance of an ovary?

Back 30

They are hypoechoic to the surrounding tissue with round, anechoic areaswithin them that represent the growing follicles

Front 31

During a routine scan of a 2 year old girl, the ovary size calculated to be 5 cc. Is this anormal value for this patient? What is the normal range for this age?

Back 31

This is larger than normal. Normal pediatric range = < 3

Front 32

How is ovarian volume calculated?

Back 32

Length x width x height (depth) x 0.52

Front 33

What is considered the normal size of an ovary?

Back 33

Pediatric years = < 3 cc

Reproductive female = 10 + 6 cc

Postmenopausal female = < 5 cc

Front 34

Suspensory ligament?

Back 34

attaches ovary to lateral pelvic wall

Front 35

Ovarian ligament?

Back 35

– attaches ovary to uterus

Front 36

Broad ligament?

Back 36

attaches uterus to lateral pelvic wall

Front 37

Round ligament?

Back 37

attaches cornua of uterus to labia majora

Front 38

Cardinal ligament?

Back 38

lateral cervix to lateral pelvic wall

Front 39

Uterosacral ligament ?

Back 39

-posterior cervix to sacrum

Front 40

Mesovarium ?

Back 40

- fold in the broad ligament (anterior to the ovary)

Front 41

Mesosalpinx?

Back 41

- fold in the broad ligament (envelopes the fallopian tube)

Front 42

What is the alternate name for the ligament---

Suspensory ligament ?

(attaches ovary to lateral pelvic wall)

Back 42

Infundibulopelvic ligament

Front 43

What is the alternate names for the ligament---

Cardinal Ligament? (2)

-– attaches lateral cervix to lateral pelvic wall

Back 43

Mackenrodt ligament and Transverse cervical ligament

Front 44

What 3 muscles compose the levator ani muscle group?

Back 44

Puborectalis

Pubococcygeus

Iliococcygeus

Front 45

What muscles are not usually demonstrated with ultrasound?

Back 45

Coccygeus

Piriformis

Front 46

Which muscles lie in the false pelvis?

Back 46

-Psoas

- iliopsoas

Front 47

Which muscle lies in the true and false pelvis?

Back 47

Rectus abdominus

Front 48

Which muscles lie in the true pelvis?

Back 48

-Obturator internus

-Piriformis

-Coccygeus X

- Levator ani (3)

Front 49

What is the linea terminalis?

Back 49

The imaginary line that separates the true and false pelvis located at the pelvicbrim/pelvic inlet.

Front 50

Is the shape of the pelvic space the same from the superior edge of the false pelvis tothe inferior edge of the true pelvis?

Back 50

No, the false is more round and the true is more oval.

Front 51

Normally, is the uterus and ovaries found in the true pelvis or false pelvis?

Back 51

-True pelvis

Front 52

Are the pelvic muscles located intraperitoneal or extraperitoneal (outside the peritonealcavity)?

Back 52

-Extraperitoneal

Front 53

What four bone make up the pelvis?

Back 53

Sacrum,

Coccyx,

Right and Left innominate bone

Front 54

What are the three parts of the innominate bone?

Back 54

- Ilium, Ischium, and Pubis

Front 55

List another 2 name(s) for the Rectouterine pouch ?

Back 55

-Pouch of Douglas

-Posterior cul de sac

Front 56

4 Parts of fallopian tube/oviduct?

Back 56

4 Parts =

-Interstitial/Intramural

-Isthmus

-Ampulla

-Infundibulum with fimbriae

Front 57

Interstitial/intramural ?

Back 57

- attaches at cornea - continuous (egg travels into uterus) (shoulder)

Front 58

Isthmus?

Back 58

Isthmus- second part of uterine tube (upper arm)

Front 59

Ampulla?

Back 59

- largest longest section, least straight, usually where fertilized, outside the cornea (lower arm)

Front 60

Infundibulum with Fimbriae ?

Back 60

- (fingers) or fimbriae tubae, are the finger-like projections located at the ends of the fallopian tubes, closest to the ovaries. The majority of the fimbriae do not touch the ovary but rather hover very close by, activated by hormones to catch a released egg and move it down into the fallopian tube.

Front 61

Do we see fallopian tubes on u/s?

Back 61

-Usually dont see fallop tubes unless it is infected or has pathology

Front 62

mesovarium?

Back 62

The mesovarium is the portion of the broad ligament of the uterus that suspends the ovaries. The ovary is not covered by the mesovarium; rather, it is covered by germinal epithelium.

Front 63

mesosalpinx ?

Back 63

The mesosalpinx is part of the lining of the abdominal cavity in higher vertebrates, specifically the portion of the broad ligament that stretches from the ovary to the level of the fallopian tube.

Front 64

Vasculature of the pelvis to the uterus

(vessel diameter?)

large to smallest?

outside uterus? inside uterus?

Back 64

outside uterus---

AO, common illiac artery, internal illiac artery uterine artery

inside uterus tissue---

Arcuate Artery, Radial Artery, Spiralarterioles,

Straight arterioles

Front 65

Arterial Uterine Blood flow?

Back 65

Aorta

Common iliac arteries

Internal Iliac arteries

Uterine arteries (Hypogastric arteries) Arcuate arteries

Radial arteries

Spiral arterioles + Straight arterioles

Front 66

Venous Uterine Blood flow?

Back 66

Uterine veins

Internal iliac veins

Common iliac veins

IVC

Front 67

Ovarian Arterial Blood Flow/Supply?

Back 67

The ovaries have 2 blood supplies

1) Aorta----> Rt + Lt ovarian artery --->ovary

2) Uterine arteries (2) ---> ovaries (2)

Front 68

Ovarian venous blood flow / return?

Back 68

Venous flow =(back to the heart via IVC)

RT Ovary---->Rt ovarian vein--->IVC (highway path)

Lt Ovary---->Lt ovarian vein--->Lt renal vein--->IVC (detour)

Front 69

the ovary sits ________to the vessels and ureter.

Back 69

-the ovary sits anterior to the vessels and ureter.

Front 70

Space of Retzius?

Back 70

Space of Retzius - fat filled, rarely seen unless full of fluid- located posterior to the symphysis pubis and anterior to the bladder

Front 71

Anterior cul-de-sac / Vesicouterine pouch?

where is it located?

Back 71

Anterior cul-de-sac / Vesicouterine pouch

vesico = bladder

-between the bladder and uterus (vesico - uterine)more anterior than posterior

Front 72

Posterior cul-de-sac / Rectouterine pouch / Pouch of Douglas ?

Back 72

3 names for one meaning = Posterior cul-de-sac / Rectouterine pouch / Pouch of Douglas

-more posterior between the rectum and the uterus (recto - uterine)

-when patient is on their back, fluid will collect here

** spaces may have free fluid depending on gravity/patient position - we need to look for it**

Front 73

The ureters ?

Back 73

The ureters themselves are usually too small to visualize (unless they are dilated).

We can determine if they are functional, however, by observing the ureteric jets

These can be demonstrated using the colour doppler mode (and are sometimes visible even without colour)

Usually two ureters/jets, a Rt and a Lt, are seen unless the patient has duplications of the ureter(s)

The ureters insert into the inferior posterior part of the urinary bladder so to visualize the jets the probe must be angled inferiorly (towards the patients feet)

The direction the jets of urine are seen is often opposite to the side of their location

Front 74

the bladder?

appearance?

Back 74

What are we looking for:

-The bladder wall should appear smooth and thin. Look for thickening, diffuse or focal

-Clear anechoic fluid in the lumen; no stones and/or debris seen

Front 75

how do we calculate bladder volume pre and post void?

Back 75

Measure bladder volume before and after urination

Pre-void volume : SAG x TRN x AP x 0.52 = volume in cc/ml

Post-void volume : SAG x TRN x AP x 0.52 = volume in cc/ml

Front 76

urethra?

Back 76

The escape route.

Voiding the urinary bladder occurs through the urethra which is located more inferior than the ureters.

The urethra (refered to as the urethral hump) is often seen as a small hypoechoic “area” at the midline inferior as aspect of the bladder and anterior to the vagina

Front 77

What’s behind the bladder?

Back 77

THE UTERUS

Once the sonographer has assured adequate bladder fullness has been achieved and completed a thorough scan for urinary pathologies, the sonographer will evaluate the female reproductive organs.

Front 78

the different uterus positions seen with flexions towards the right or left sides?

Back 78

left = levorotated

right = Dextrorotated

A patient may have variations of both anterior to posterior flexion and side to side flexion.

Front 79

the cervix?

Back 79

-The cervix is the most inferior part of the uterus and is cylindrical in shape.

-The endocervical canal is the passage way that runs through the inner part of the cylinder. It is lined with mucosa (appears echogenic on ultrasound).

-In the transverse plane, shadowing will be seen from the edges of the cervix. (vampire teeth) The shadowing comes from the fornices…tiny recesses (spaces) where the inferior part of cervix projects into the superior part of the vagina

Front 80

vag?

Back 80

The vagina is a long, collapsed muscular tube located inferior to the cervix. The inner part of the “tube” (the vaginal canal) is lined with mucosa (appears echogenic on ultrasound)

Front 81

the ovaries?

-location?

appearance on u/s?

Back 81

The ovaries are paired, small, ovoid-shaped organs located in the adnexa of the female pelvis.They usually that contain a varying number of small, round, fluid-filled follicles. Structures that are fluid-filled often appear anechoic (black) on ultrasound.

Front 82

u/s appearance of ovaries?

Back 82

Sonographic Appearance:Hypoechoic compared to surrounding structuresVarying number of small, anechoic follicles

Front 83

Ovarian Position?

Back 83

-Variable (but will not be anterior to the uterus)

-Lie in ovarian fossa or Fossa of Waldeyer

-Within the peritoneal cavity (intraperitoneal organs)

-Use iliac arteries as guide.

-MID SAGITAL to see canal top to bottom

Front 84

Each ovary has______ arterial blood supplies

Back 84

Each ovary has two arterial blood supplies:

1- Ovarian artery – branch directly off abdominal aorta

2- Branch from uterine artery

Front 85

Each ovary has ____ venous drainage system via:

Lt Ovarian vein > empties into left renal vein

Rt ovarian vein > empties into IVC

Back 85

Each ovary has one venous drainage system via:

Lt Ovarian vein > empties into left renal vein

Rt ovarian vein > empties into IVC

Front 86

Ovarian volume calculation?

Back 86

Length x Width x Height x 0.523 =

ie: Sag x Trn x AP x 0.523 = ____

Front 87

the ligament that suspends the ovary from the pelvis wall ?

Back 87

Infundibulopelvic ligament

aka

suspensory ligament

Front 88

the hammock shaped group of muscles that supports the pelvic organs?

Back 88

levator ani

Front 89

the portion of the uterus which undergoes the most change under the influence of hormones?

Back 89

the zona functionalis layer

Front 90

which ligament is responsible for anteversion/flexion?

Back 90

round ligament

Front 91

the longest portion of the uterine tube ?

aka fallopian tube

Back 91

the ampulla

Front 92

the ovaries are located on a shallow depression of the broad ligament called the ?

Back 92

fossa of Waldeyer

Front 93

the age group which would have a 1:1 uterus to cervix ratio ?

Back 93

post menopausal

Front 94

the age group which would have a 1:2 uterus to cervix ratio ?

Back 94

newborn

1 uterus 2 cervix

Front 95

what structure produces the liner shadowing on a transverse image of the cervix?

Back 95

the fornices